Laparoscopic wound closure device

ABSTRACT

A laparoscopic wound closure device includes an elongated body portion including a proximal end, a distal end, and a pair of vertical suture channels. Each vertical suture channel has an entrance at the proximal end and an exit near the distal end for passing a suture needle through, and travels parallel to the longitudinal axis of the body portion of the device. The vertical suture channels are designed to cause a suture needle to deflect laterally as it exits the wound closure device. The wound closure device can be an obturator or a sheath of a trocar assembly, and can be used to inject local anesthetic at the conclusion of surgery.

FIELD OF THE INVENTION

The present invention relates generally to surgical suturing devices,and more particularly to abdominal suturing devices designed for closinglaparoscopic puncture wounds.

BACKGROUND OF THE INVENTION

Laparoscopic surgery, or minimally invasive surgery, has replaced manystandard invasive abdominal operations that require large incisions.Current laparoscopic surgical techniques include the creation of smallincisions in the lateral abdominal wall, into which one or more surgicaltrocar assemblies or other similar puncturing devices are placed. Atrocar assembly is typically comprised of an obturator having apuncturing distal end, and a sheath or cannula which is adapted to slideover the outer diameter of the obturator. The obturator and cannula aretypically used together to puncture the lateral abdominal wall to gainaccess to the surgical site. Once the puncture is made, the obturator isremoved from the hollow cannula creating a port for introducing andremoving various surgical instruments. Scissors, dissectors, retractors,and biopsy instruments can be manipulated through a plurality ofsurgically placed ports, together with viewing devices such asendoscopes or laparoscopes, to perform surgery or diagnostic procedures.The intraperitoneal space is typically insufflated with pressurizedcarbon dioxide to provide more room and better exposure for viewing theanatomy and manipulating the instruments through the ports. Thistechnology affords the patient considerably less pain and disfigurement,and a much faster recovery.

Upon completion of the laparoscopic procedure, the remaining trocarwounds are preferably sutured to close the wound. Closure of thesewounds requires proper identification and closure of the underlyingabdominal wall layers of connective tissue and muscle. If these fasciallayers are not properly aligned and sutured closed, bowel herniation atthe port site (a “port site hernia”) can result, as well as thepossibility of bowel strangulation or omental trapping. Because of thelimited exposure provided by the very small size of the incision and thesomewhat awkward, external access to the tissues surrounding theincision, proper closure of trocar wounds can be problematic and timeconsuming. Successful closure is also often further compromised bypatient obesity and other factors.

When closing a lateral abdominal puncture wound the suturing needleshould not only secure an optimal amount of tissue to prevent herniationbut also avoid sensory and motor nerves present in the more superficiallayers of the lateral abdominal wall. Specifically, the iliohypogastric,ilioinguinal and thoraco-abdominal nerves typically travel along asuperficial fascial plane just beneath the internal oblique muscle, butnot in the deeper layers that include the transversalis fascia,pre-peritoneal fat and the peritoneum. Thus, avoiding the moresuperficial layers of the lateral abdominal wall and passing the sutureneedle to close only the deeper fascial planes can avoid nerveentrapment or post-operative neuropathy, while still sufficientlyclosing the wound.

Current port site closure devices, such as that disclosed by U.S. Pat.No. 6,183,485 to Thomason et al. or U.S. Pat. No. 6,743,241 to Kerr,both of which are incorporated herein by reference in their entirety,close abdominal wall laparoscopic port sites via a “mass closure” devicein order to prevent post-operative herniation. However, such massclosure devices use an approach in which the suture needle is passedindiscriminately and/or at an oblique angle through virtually allfascial layers of the lateral abdominal wall (see, e.g., FIG. 2, suture32), which can lead to long term postoperative pain in the form of nerveentrapment, post-operative neuropathy and/or the need to surgicallyremove the suture.

While known abdominal wound closure devices may be useful for theirintended purposes, it would be beneficial provide a wound closure devicein which the suture needle avoids the superficial abdominal fasciallayers containing nerves. There is also a need for an improved deviceand method for closing abdominal wound sites that can minimize the riskof nerve entrapment, post-operative neuropathy, puncture site herniationor other undesirable side effects of laparoscopic surgery. It would alsobe advantageous to provide a surgical device and method that can beutilized by surgeons having various skill levels.

SUMMARY OF THE INVENTION

Briefly stated, the wound closure device according to the variousembodiments of this invention can decrease and/or eliminate theoccurrence of nerve entrapment or post-operative neuropathy, while stillsecuring an optimal amount of tissue to prevent post-operativeherniation at the port site.

One aspect of the invention provides a wound closure device, the devicecomprising an elongated body portion including a proximal end, a distalend, and a pair of vertical suture channels, each vertical suturechannel having an entrance at the proximal end and an exit near thedistal end for passing a suture needle through, wherein the verticalsuture channels travel parallel to the longitudinal axis of the bodyportion and cause the suture needle to deflect laterally as it exits thesuture channel.

Another aspect of the invention provides an obturator of a trocarassembly for closing a trocar puncture wound, comprising an elongatedbody portion having a proximal end, a sharp distal end, and a pair ofvertical suture channels, each vertical suture channel located withinthe body portion and having an entrance at the proximal end and an exitnear the distal end for passing a suture needle through, wherein thevertical suture channels travel parallel to the longitudinal axis of thebody portion and curve laterally within the body portion at the exit,thereby causing the suture needle to deflect laterally as it exits thesuture channel.

Another aspect of the invention provides a sheath of a trocar assemblyfor closing a trocar puncture wound, comprising an elongated bodyportion having a proximal end, a distal end, a hollow passage extendinglongitudinally therethrough, and a pair of vertical suture channels,each of the vertical suture channels located along the outside of thesheath and having an entrance at the proximal end and an exit near thedistal end for passing a suture needle through, wherein each of thevertical suture channels travels parallel to the longitudinal axis ofthe body portion and includes a deflection ridge at the exit that causesthe suture needle to deflect laterally as it exits the suture channel.

The disclosed embodiments of the inventive device can be used forclosing a laparoscopic puncture wound according to the steps ofinserting the inventive device into the puncture wound; using a suturepassing device to insert a suture needle through a first of the pair ofvertical suture channels; piercing the deep fascial planes and avoidingthe superficial layers of the lateral abdominal wall with the sutureneedle as it exits the first vertical suture channel; grasping thesuture needle with a pickup instrument; passing the suture needle to thesuture passing device, which has been passed through the second verticalsuture channel; pulling the suture needle back through the second suturechannel with the suture passing device; removing the wound closuredevice; and knotting the suture to close the wound.

The nature and advantages of the present invention will be more fullyappreciated after reviewing the accompanying drawings, detaileddescription and claims.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings illustrate embodiments of the invention and,together with a general description of the invention given above, andthe detailed description given below, serve to explain the principles ofthe invention.

FIG. 1 is a cross-sectional view depicting the anatomy of the anteriorabdominal wall;

FIG. 2 is a cross-sectional side view showing two types of sutureclosure of a trocar wound through the lateral abdominal wall;

FIG. 3 is cross-sectional plan view of a wound closure device accordingto one embodiment of the present invention;

FIG. 4 is a top, plan view of the wound closure device of FIG. 3;

FIG. 5 is a cross-sectional view of the wound closure device of FIG. 3placed in the trocar wound of FIG. 2;

FIG. 6 is a cross-sectional plan view of a wound closure deviceaccording to another embodiment of the present invention;

FIG. 7 is a cross-sectional view of the wound closure device of FIG. 6placed in the trocar wound of FIG. 2;

DETAILED DESCRIPTION OF THE INVENTION

FIG. 1 illustrates the general anatomy of the abdominal wall 10, whichis initially covered by a layer of skin 14 and fat 16 and composed ofpairs of muscles, notably the rectus abdominis 11, the external oblique18, the internal oblique 22, and the transversus abdominis 26 muscles.These muscles and their fascial attachments, notably the externaloblique fascia 20, the internal oblique fascia 24 and the transversalisfascia 28, interdigitate and unite to form a sturdy, protectivemusculofascial layer that gives strength and support to theanterolateral abdominal wall. Below the level of the transversalisfascia 28, a layer of pre-peritoneal fat 29 precedes the peritoneum 30.The pre-peritoneal fat 29 is of varying thickness from patient topatient, ranging from zero mm to about 20 mm depending on factors suchas the body fat index of the patient. The peritoneum 30 is a smooth,serous membrane that forms the lining of the intraperitoneal spacewithin the abdominal cavity.

A trocar wound 12 that penetrates the above-noted layers of the lateralabdominal wall 10 is best seen in FIG. 2. During laparoscopic surgery atrocar wound 12 pierces the layers of the lateral abdominal wall,puncturing (in order) the skin 14, subcutaneous fat 16, the externaloblique muscle 18, the external oblique fascia 20, the internal obliquemuscle 22, the internal oblique fascia 24, the transversus abdominismuscle 26, the transversalis fascia 28, the pre-peritoneal fat 29 andthe peritoneum 30. Sutures 32, 34 are shown, which are placed for eithera mass closure 32 according to the prior art, or a deep closure 34according to the present invention, in order to close the wound.

The arrow indicated by N in FIG. 2 indicates the superficialfascia/muscle layers, in which the majority of large sensory and motornerves of the lateral abdominal wall are located. These layers generallycomprise the internal oblique fascia 24 and higher (i.e. generallylayers 18-24. Sutures placed by prior art mass closure devices, as shownby the placement of suture 32, passes the suture needle at an obliqueangle through the superficial fascia and muscle layers indicated byarrow N, putting the iliohypogastric, ilioinguinal and thoraco-abdominalnerves at risk of entrapment and/or causing post-operative neuropathy.The present invention provides an improved wound closure device for deepplacement of a suture 34, in which the suture needle is first passedvertically through the wound, within a vertical passage of the inventiveclosure device, and exits to penetrate the deep fascial planes only(i.e. the transversus abdominis muscle and deeper), avoiding thesuperficial layers N of the lateral abdominal wall. FIG. 2 shows a deepsuture 34 of the present invention placed through the deep fascialplanes (i.e. a portion of the transversus abdominis muscle 26, thetransversalis fascia 28, the pre-peritoneal fat 29, and the peritoneum30). Isolating the deep fascial planes and placement of a deep suture 34in this manner can decrease and/or eliminate the occurrence of nerveentrapment or post-op neuropathy, while still securing an optimal amountof tissue to prevent herniation.

One embodiment of the inventive device, as shown in FIGS. 3, 4 and 5, isa wound closure device 40 having an elongated body portion 45 includinga proximal end 41 (with an ergonomic handle 43), a distal end 50 with apenetrating tip 51, and a pair of vertical suture channels, e.g. a firstvertical suture channel 42 and a second vertical suture channel 44located in and passing through the body 45 of the wound closure device40. Each vertical suture channel 42, 44 has an entrance 47, 49 at theproximal end 41 and travels parallel to the longitudinal axis A-A of thebody portion 45. As the vertical channels 42, 44 near the distal end 50of the wound closure device they curve and exit the side of woundclosure device via exits 53, 55. Exits 53 and 55 are located directlyabove the zero line 100 of depth markers 48, located at the distal end50 of the device. The diameter of the body portion 45 of the woundclosure device 40 should be chosen to fit the diameter of the wound 12(see FIG. 2) created during surgery, and typically can be made to have adiameter of between 5 (five) mm and 20 (twenty) millimeters. If thewound closure device 40 is an obturator for a trocar assembly, then thediameter of the body portion 45 should be chosen to fit the diameter ofthe sheath of the trocar assembly.

The curve of the vertical suture channels 42, 44 at the distal end 50 ofthe wound closure device 40 will deflect and/or direct the suture needlelaterally through the exits 53, 55. The channels 42, 44 can be curved atan angle of between 20° and 60° and preferably at an angle of between30° and 45° from the longitudinal axis A-A of the wound closure device40 to direct the suture needle laterally. Lateral deflection of thesuture needle 60 by the channels 42, 44 in this manner causes the sutureneedle to take a large enough “bite” of the deepest fascial layers, i.e.the peritoneum 30, the pre-peritoneal fat 29 and the transversalisfascia 28, and optionally a deep portion of the transversus abdominismuscle 26. This approach can avoid the iliohypogastric, ilioinguinal andthoraco-abdominal nerves typically traveling closer to the skin surface14, such as in the internal oblique fascia 24 running between theinternal oblique muscle 22 and transversus abdominis muscle 26. Closingthe peritoneum 30 and the transversalis fascia 28 is generally adequatefor closing the puncture wound 12 and preventing the risk of herniationat the port site, nerve entrapment or post-operative neuropathy. Lateraldeflection of the suture needle within the degree ranges noted abovetypically does not present a problem of bending the needle, since theneedle can be made of a flexible metal as is known in the art.

Depth markers 48 located near the distal end 50 of the wound closuredevice 40 are used to determine the depth of suture placement (see FIG.5). It is notable that the depth markers 48 do not represent how fardown the suture is placed below the skin 14, but rather the depthmarkers 48 measure how far the suture is placed above the level of theperitoneum 30. The depth markers can be visualized by the surgeon via anendoscope inserted into the insufflated intraperitoneal space through aseparate port. Zero line 100, as illustrated in FIGS. 3 and 5, is adepth marker that represents essentially 0.0 millimeters (mm) from itsalignment with the peritoneum 30 to the suture exits 53, 55, which arelocated directly above the zero line 100. Thus, alignment of the zeroline 100 with the peritoneum 30 will ensure that the suture needle atleast passes through the peritoneum 30.

However, as noted above, the pre-peritoneal fat layer 29 (between theperitoneum 30 and the transversalis fascia 28) is variable in thicknessfrom patient to patient. In obese patients, the depth markers 48 locatedbelow the zero line 100 can be placed at the level of the peritoneum 30to ensure that the suture needle exits above the peritoneum 30 and abovethe layer of pre-peritoneal fat 29 to also pass through thetransversalis fascia 28 and perhaps the deeper portion of thetransversus abdominis muscle 26. The depth markers can be labeled in anymanner desired (i.e. mm, inches, etc.), but typically should measure upto about 20 (twenty) mm from the zero line 100, thus allowing thesurgeon to take into account the thickness of the patient'spre-peritoneal fat layer 29 and then judge how high above the peritoneum30 the suture needle should be passed to adequately close the wound 12.

Stability ridges 46, as illustrated in FIGS. 3 and 5, are raisedsemi-circular ridges which typically protrude 1 mm to 2 mm from theouter circumference of the body portion 45. These ridges 46 hold thewound closure device 40 in place during use by virtue of the roughsurface created by the raised ridges. The stability ridges 46 thereforeincrease friction between the wound tissue 12 and the device 40 to keepthe device from sliding up and down during wound closure.

As can be appreciated from viewing FIG. 5, a flexible suture passingdevice 61 (as is known in the art) can be used to pass a suture needle60 through the vertical suture channels 42 and 44. After the suture 57and suture needle 60 are passed through the exit 53, thereby penetratingthe deep fascial layers on one side of the device (e.g. the left side,as shown), the suture 57 is grasped with a pickup 52 from another portand “fed” to the suture needle 60 which has been passed via the passingdevice 61 through exit 55 of the opposite suture channel 44. The sutureis then pulled back through the opposite suture channel and tied, withthe surgical knot being placed deep into the puncture wound, generallyat the level of the transversus abdominis muscle 26. This can beaccomplished by the surgeon by initially removing the device 40 from thewound 12 once the suture 57 has been passed through the deep fascia onboth sides of the wound 12. The surgeon can then tie the suture 57 intoa surgical knot as the two suture ends exit the skin 14, and then pushthe knot down into the deeper fascial layers. A grasper or other type ofknot passing device as is known in the art can be used to help tie thesuture and tuck it into the wound. Further, tying and knotting thesuture at the level of the deep fascial layers, as shown by suture 34 inFIG. 2, can evert the fascial edges of the wound 12 towards the skinsurface, thereby allowing the surgeon to isolate and thus betterapproximate the torn edges of the deep fascial layers.

One embodiment of the invention, illustrated in FIG. 6, provides a woundclosure device 70 in the form of a sheath or hollow cannula. This sheathembodiment can not only be used to close the wound, but it can alsoserve as the “port” during the laparoscopy for insertion andmanipulation of instruments. When the time comes to close the wound 12,the surgeon can simply remove the tools and close the wound using thisport. As illustrated, the wound closure device 70 has an elongated bodyportion 75 including a proximal end 71 (with an ergonomic handle 73) anda hollow distal end 81. A pair of side ports 72, 74 form entrances atthe proximal end 71 for a suture passing device, and lead to verticalsuture channels 76, 78 which run externally to the body 75 of the sheath70. Each vertical suture channel 76, 78 travels parallel to thelongitudinal axis A-A of the body portion 75, but the channels end atexits 93, 95 as they near the distal end 81 of the sheath 70. Exits 93and 95 are located directly above the zero line 101 of depth markers 84,located at the distal end 81 of the device. The diameter of the bodyportion 75 of the wound closure device 70 should be chosen to fit thediameter of the wound 12 (see FIG. 2) created during surgery, andtypically can be made to have a diameter of between 5 (five) mm and 20(twenty) millimeters. If the wound closure device 70 doubles as asheath/port for a trocar assembly the diameter of the body portion 75should be chosen to fit the diameter of the obturator of the trocarassembly.

Looking at FIG. 7, lateral deflection of the suture needle 60 by thedeflection ridges 80, 82 as it passes through exits 93 or 95 causes theneedle 60 to travel laterally to take a larger “bite” of the deepestfascial layers, while avoiding nerves typically traveling in thesuperficial abdominal layers. As noted above, avoiding the superficiallayers of the lateral abdominal wall and passing the suture needlethrough the deeper fascial planes in this manner can prevent nerveentrapment or post-operative neuropathy, while also adequately closingthe wound and preventing the risk of herniation at the port site.

The deflection ridges 80, 82 cause the needle to curve at an angle ofbetween 20° and 60° and preferably at an angle of between 30° and 45°from the longitudinal axis A-A of the wound closure device 70 to directthe suture needle laterally. The deflection ridges 80, 82 can alsoinclude indentations (not shown) to ensure guiding of the suture needlelaterally, and to prevent slippage of the needle anteriorly orposteriorly off of the side of the deflection ridge. For example, asemi-circular notch, score or indentation can be included on the topsurface of each deflection ridge 80, 82 to aid in lateral guidance ofthe flexible suture passing device 61 and the needle 60 at the exits 93,95 of the vertical suture channels 76, 78.

The zero line 101 and other depth markers 84 (see FIG. 6) located nearthe distal end 81 of the wound closure device are used to determine thedepth of suture placement (see FIG. 7). It is notable that the depthmarkers do not represent how far down the suture is placed below theskin, but rather the depth markers 84 measure how far the suture isplaced above the level of the peritoneum 30. The depth markers can bevisualized by the surgeon via an endoscope inserted into the insufflatedintraperitoneal space through a separate port. Zero line 101, asillustrated in FIGS. 6 and 7, is a depth marker that representsessentially 0.0 millimeters (mm) from its alignment with the peritoneum30 to the suture exits 93, 95, which are located directly above the zeroline 101. Thus, alignment of the zero line 101 with the peritoneum 30will ensure that the suture needle at least passes through theperitoneum 30. However, as noted above, the depth markers 84 locatedbeneath the zero line 101 on the device 70 can be placed at the level ofthe peritoneum 30 to ensure that the suture needle exits above theperitoneum 30 and above the layer of pre-peritoneal fat 29 to also passthrough the transversalis fascia 28 and perhaps the deeper portion ofthe transversus abdominis muscle 26.

Stability ridges 86, as illustrated in FIG. 6, are raised semi-circularridges which typically protrude 1 mm to 2 mm from the outercircumference of the body portion 75. These ridges 86 hold the woundclosure device 70 in place during use by virtue of the rough surfacecreated by the raised ridges. The stability ridges 86 therefore increasefriction between the wound tissue 12 and the device 70 to keep thedevice from sliding up and down, both during use as a “port” during theprocedure and during wound closure.

As can be appreciated from viewing FIG. 7, a suture needle 60 can bepassed initially through a first vertical suture channel, such as suturechannel 78, using a flexible suture passing device (e.g. 61, as seen inFIG. 5). After the suture 57 and suture needle 60 are passed through theexit 93, thereby penetrating the deep fascial layers on one side of thedevice (e.g. the left side, as shown), the suture 57 is grasped with apickup 52 from another port and “fed” to the suture needle 60 which hasbeen passed through exit 95 of the opposite suture channel 76. Thesuture is then pulled back through the opposite suture channel 76 andtied, with the surgical knot being placed deep into the puncture wound,generally at the level of the transversus abdominis muscle 26. This canbe accomplished as described above.

The various embodiments of the inventive wound closure device disclosedherein can be manufactured as a separate surgical wound closure device40, 70 inserted specifically for closure of the puncture wound, or itcan be part of a trocar assembly, such as an obturator 40 (FIG. 3) or asheath 70 (FIG. 6) of a trocar assembly that can be used during thesurgery as well as during closure. The various embodiments of the woundclosure device disclosed herein can also be used to inject an analgesicor anesthetic medication at the conclusion of the surgery, as theassembly is withdrawn from the incision. After suturing is completed, aspinal needle can be introduced via the exits 53, 55 of the verticalsuture channels 42, 44 of the obturator 40 (see FIGS. 3-5), and/or theexits 93, 95 of the vertical suture channels 76 and 78 of the sheath 70(see FIGS. 6 and 7). Medication such as local anesthetic can be placedinto the tissues immediately affected by the trocar wound/tract,including punctured surfaces of the skin 14, external oblique muscle 18,the external oblique fascia 20, the internal oblique muscle 22, theinternal oblique fascia 24, the transversus abdominis muscle 26, thetransversalis fascia 28, the pre-peritoneal fat 29 and the peritoneum30. Medication can be injected by needle and syringe to the surgicalwound site via the vertical suture channels, beginning in the deepertissues and ending at the skin surface as the surgeon removes the woundclosure device 40, 70 from the wound 12.

In this manner, analgesic can be applied to the surgical wound site viathe vertical suture channels as the inventive is device is removed atthe conclusion of surgery, so that the local anesthetic is at maximumstrength at the “actual” surgical site immediately post-operatively, andnot at an “intended site” prior to incision and trocar placement, as iscurrently typically performed. The inventive device can thereforeprovide the ability to place post-operative analgesic or anestheticmedication where and when it is needed most. Placing analgesics prior toincision can lead to its application in the wrong place, with such earlyplacement resulting in metabolization of the analgesic during theprocedure, thereby lessening any post-operative pain relief.

The inventive device allows the suture to bypass and thus notincorporate the superficial layers of the lateral abdominal wall in thewound closure. The lateral diversion of the suture with a flexiblesuture passing device does not occur until the suture reaches the deeperlayers of the abdominal wall. Such deep placement of the suture allowsthe surgeon to close only the deepest layers of the lateral abdominalwall in a specific manner, so as to avoid the nerves traveling in themore superficial layers. The depth markers are incorporated at thedistal end of the device allow the surgeon to judge how far above theperitoneal surface the suture can be placed to compensate for patientshaving variable degrees of pre-peritoneal fat.

While the present invention has been illustrated by the description ofparticular embodiments in considerable detail, it is not intended torestrict or limit the scope of the appended claims to such detail.Additional advantages and modifications will be readily apparent tothose skilled in the art without departing from the concept or scope ofthe invention.

What is claimed is:
 1. A wound closure device for placement of a suturewithin the deep fascial layers of an abdominal wall puncture wound, thedevice comprising an elongated body portion including a longitudinalaxis, a proximal end, a distal end, a plurality of depth markers locatedat the distal end, and a pair of vertical suture channels, each verticalsuture channel having an entrance at the proximal end and an exit nearthe distal end for passing a suture needle through, wherein each suturechannel travels parallel to the longitudinal axis of the body portionand is configured to cause the suture needle to deflect laterally at thesuture channel exit, wherein each suture channel exit is locateddirectly above a first of the plurality of depth markers, and whereineach of the plurality of depth markers indicates a distance from thesuture channel exits.
 2. The device of claim 1, wherein the device is asheath for a trocar assembly, the sheath including a hollow passageextending longitudinally therethrough, and wherein each of the verticalsuture channels are located along the outside of the sheath and includea deflection ridge at the exit for causing the suture needle to deflectlaterally as it exits the suture channel.
 3. The device of claim 2,wherein each of the vertical suture channels includes a side portforming the entrance at the proximal end.
 4. The device of claim 1,further comprising stability ridges along the exterior of the bodyportion for holding the device in place during use.
 5. The device ofclaim 1, wherein the distance from the suture channel exits indicated byone of the plurality of depth markers is the distance that the suturewill be placed above the level of the peritoneum of the wound when theone depth marker is positioned at the level of the peritoneum.
 6. Thedevice of claim 1, wherein the deep fascial layers of the abdominal wallpuncture wound include the peritoneum, the pre-peritoneal fat, and thetransversalis fascia, and do not include the internal oblique fascia,the internal oblique muscle, the iliohypogastric nerve, the ilioinguinalnerve, the thoraco-abdominal nerve, the external oblique fascia, or theexternal oblique muscle.
 7. The device of claim 6, wherein the deepfascial layers of the abdominal wall puncture wound also include a deepportion of the transversus abdominis muscle.
 8. A sheath of a trocarassembly for closing an abdominal wall puncture wound by placement of asuture within the deep fascial layers of the wound, the sheathcomprising an elongated body portion having a longitudinal axis, aproximal end, a distal end, a hollow passage extending longitudinallytherethrough, a plurality of depth markers located at the distal end,and a pair of vertical suture channels, each of the vertical suturechannels located along the outside of the sheath and having an entranceat the proximal end and an exit near the distal end for passing a sutureneedle through, wherein each of the vertical suture channels travelsparallel to the longitudinal axis of the body portion and includes adeflection ridge at the exit for causing the suture needle to deflectlaterally as it exits the suture channel, wherein each suture channelexit is located directly above a first of the plurality of depthmarkers, and wherein each of the plurality of depth markers indicates adistance from the suture channel exits.
 9. The device of claim 8,wherein each of the vertical suture channels includes a side portforming the entrance at the proximal end.
 10. The device of claim 8,further comprising stability ridges along the exterior of the bodyportion for holding the device in place during use.
 11. The device ofclaim 8, wherein the distance from the suture channel exits indicated byone of the plurality of depth markers is the distance that the suturewill be placed above the level of the peritoneum of the wound when theone depth marker is positioned at the level of the peritoneum.
 12. Thedevice of claim 8, wherein the deep fascial layers of the abdominal wallpuncture wound include the peritoneum, the pre-peritoneal fat, and thetransversalis fascia, and do not include the internal oblique fascia,the internal oblique muscle, the iliohypogastric nerve, the ilioinguinalnerve, the thoraco-abdominal nerve, the external oblique fascia, or theexternal oblique muscle.
 13. The device of claim 12, wherein the deepfascial layers of the abdominal wall puncture wound also include a deepportion of the transversus abdominis muscle.
 14. A method for closing alaparoscopic abdominal wall puncture wound by placement of a suturewithin the deep fascial layers of the wound, the method comprising thesteps of: a) providing a device for placement of a suture within thedeep fascial layers of an abdominal wall puncture wound while avoidingthe superficial layers of the wound, the device comprising an elongatedbody portion including a longitudinal axis; a proximal end; a distalend; a plurality of depth markers located at the distal end; and a pairof vertical suture channels, each vertical suture channel having anentrance at the proximal end and an exit near the distal end for passinga suture needle through, wherein each suture channel travels parallel tothe longitudinal axis of the body portion and is configured to cause thesuture needle to deflect laterally at the suture channel exit, whereineach suture channel exit is located directly above a first of theplurality of depth markers, and wherein each of the plurality of depthmarkers indicates a distance from the suture channel exits; b) insertingthe elongated body portion of the device into the puncture wound; c)positioning one of the plurality of depth markers at the level of theperitoneum of the puncture wound, wherein the distance from the suturechannel exits indicated by the one depth marker is the distance that thesuture will be placed above the level of the peritoneum; d) using asuture passing device to insert a suture needle through a first of thepair of vertical suture channels; e) piercing the deep fascial, planesand avoiding the superficial layers of the abdominal wall puncture woundwith the suture needle as it exits the first vertical suture channel; f)grasping the suture needle with a pickup instrument; g) passing thesuture needle to the suture passing device, which has been passedthrough the second vertical suture channel; h) pulling the suture needleback through the second suture channel with the suture passing device;i) removing the wound closure device; and j) knotting the suture toclose the wound.
 15. The method of claim 14, wherein the device is asheath for a trocar assembly, the sheath including a hollow passageextending longitudinally therethrough, and wherein each of the verticalsuture channels are located along the outside of the sheath and includea deflection ridge at the suture channel exit for causing the sutureneedle to deflect laterally.
 16. The method of claim 14, furthercomprising the step of injecting an analgesic or anesthetic medicationvia the vertical suture channels as the device is removed from thewound.
 17. The method of claim 14, wherein the suture needle pierces theperitoneum, the pre-peritoneal fat, and the transversalis fascia of theabdominal wall puncture wound, but does not pierce the internal obliquefascia, the internal oblique muscle, the iliohypogastric nerve, theilioinguinal nerve, the thoraco-abdominal nerve, the external obliquefascia, or the external oblique muscle.
 18. The method of claim 17,wherein the suture needle also pierces a deep portion of the transversusabdominis muscle.